Issues of right or wrong aside, said Moreno, it would be hard for the public to regulate the technique: because the U.S. government doesn't fund IVF research, it can't provide much guidance for reproductive technologies. If the public is going to have a role in science – and not just in saying something is morally good or bad, but making sure it's done right, guiding it in a productive way – then the public needs to fund it.

The same principle holds for embryonic stem cell research, which receives very limited federal funding. If the promised therapies arrive, the public might not have a chance to make sure they're affordable.__What's your take on this?__

There are going to be a lot of techniques that offer people in gay couples the chance to reproduce in non-traditional ways. This is one possible pathway. We are going to be facing some very interesting social questions about how far this goes.

The two papers published last fall on induced pluripotent stem cells – very few people have noticed that if you can turn a skin cell into a pluripotent cell, and then into a pancreatic cell, you can probably also turn it into sperm cell, or an egg cell, or even a blastomere.

The [Newcastle technique] is one pathway that gives an option for people who either medically or situationally can't engage in sexual reproduction in traditional way. The key element here is that it lets them use their own DNA.

__But this is the only technique that people in a three-person relationship could use.__

It would look like that. It makes you wonder, how many could we get involved....

__If it proves safe, could it catch on in the United States?__

With economies of scale, one wouldn't want to eliminate the possibility that it'll be cheap enough to do this. IVF clinics will be very good at creating a break point in the price that people find attractive.

And I wouldn't want to rule out that people will want this. In our society, we create a lot of space for people to have reproductive freedom – so i think the burden of proof is on people who would say,"Is this bad? If not for the child, then society?"

If this turns out to be a high-tech way to be fruitful and multiply, and it's safe, then it falls into a space that most Americans are willing to accept, even if they're not wild about it.

At the same time, it excites the free-floating anxiety about how far biology can go. But on a case by case basis, it's hard to put up a stop sign.

__Couldn't you draw a stop sign at the intention – say it's okay for medical reasons, but not for purely procreational reasons?__

We're not in a good position to tell people how to have kids.

But we are in a position to say it's an area where the public doesn't want to invest – and that decision was already made 28 years ago in the US with IVF research. And the result of that is that if government isn't involved early on in the research, it doesn't have an opportunity to set ethical standards.

That's one of the ironies about IVF and stem cells – it's partly because the U.S. government pulled out in 1980 from IVF research that the fertility field developed on its own. And now there's lots of concern about its practices and standards. That's the downside of not geting involved. [People who are morally opposed to this] shouldn't support this necessarily – but the political system kind of controls it.

[If goverment funds the research] then you create a culture of responsibility around that technology. It wouldn't be perfect or foolproof – but people would have a sense of where they could go, where it would not be acceptable to go. Whereas if you say, "It's a matter for the market to decide," the boundary conditions are a lot fuzzier.

It puts bioconservatives in a very odd position: if they say no to government funding, they leave open the possibility of creating a WildWest scenario. But if they shrug shoulders and say government has to get into this to create a moral culture down the road, then they look as though they're endorsing it.

__That's not exactly the sort of nuance that thrives in our political culture.__

No, it's not.

Very much the same has happened in the stem cell debate. By minimizing the role of the federal government in embryonic stem cells, you've to a great extent taken the NIH out of rulemaking. But the research has been successful, and that's encouraging people using non-federal funds to push forward.

What does that mean in terms of stem cell therapy accessibility?

I think access is a big problem. I was the co-chair of the NationalAcademy of Sciences committee that developed ethical guidelines for embryonic stem cell research. There's now a successor to that committee, and we're concerned with the justice issues.

With an exotic new therapy, it takes a long time for insurance companies to figure out how to price it. So for a very long time, people with only some kind of means can get it. That's a concern.

Many people believe – and there's no answer to this now – that customized stem cells on a per-person basis will never be cost-effective. Instead we'll need to come upt with a suite of cells that are genetically compatible with most people. You may never have individualized therapies.

__But even such a general suite of cells could still be prohibitively expensive.__

The justice issues still apply to it. In the first years, it's going to be expensive. Take the heart transplant – it took a long time for consumers to get on board.

Of course, that's a problem a problem we'd love to have. First we have to get to a point with regenerative medicine that we're using modified pluripotent cells to fix tissues and organs. But it's enough of a concern, at this stage, that our committee is thinking about it.